Abstract
Aims and Objectives:
Over the last decade, YouTube has been extensively used as a learning tool for both physicians and patients, but the reliability of this information remains questionable. The purpose of this study was to look for the reliability and quality of videos on tennis elbow arthroscopy on YouTube.
Materials and Methods:
We used three search terms on YouTube “tennis elbow arthroscopic surgery,” “Arthroscopic ECRB release,” and “Arthroscopic debridement for tennis elbow,” and screened the first 50 videos according to popularity. The videos were included from 2009 to date. Only videos in the English language were included. Repeated videos and videos without sound were excluded. A total of 74 videos were selected for this study and reliability was checked with DISCERN and journal of the American medical association (JAMA) scores. The quality was assessed with the Global Quality Score Criteria (GQSC) score and TEARS (a novel score). Popularity was tested with the video power index (VPI). A pilot study was conducted using 20 videos to validate the TEARS score.
Results:
In the pilot study, TEARS showed results in accordance with other scores used. The average number of views was 41,644.97, and the average duration was 5.03 ± 3.39 years. The mean value of DISCERN and JAMA was found to be 21.47 ± 6.28 and 1.05 ± 0.92, respectively. GQSC, TEARS, and VPI were found to be 1.70 ± 0.82, 4.17 ± 2.62, and 769,936.9 ± 6,538,851.37.
Conclusion:
Most of the videos were educational and physicians were targeted. The USA was the major contributor to such videos. The reliability and quality of these videos were found to be of poor quality. The video popularity was however found to be relatively high. The inter-observer reliability was good. Based on the findings, we conclude that the videos are not reliable and could not be used for learning.
Keywords: Arthroscopic elbow debridement, arthroscopic elbow release, ECRB debridement, ECRB release, elbow arthroscopy, lateral epicondylitis, tennis elbow
Introduction
Tennis elbow (TE) is one of the most common causes of chronic lateral elbow pain. It is also known as lateral epicondylitis as it involves the area of common extensor origin (CEO)—Extensor Carpi Radialis Brevis (ECRB).[1] The repeated micro-ruptures at the lateral epicondyle due to overuse of extensor muscles result in this recurrent painful condition affecting regular daily activities. Diagnosis is made on clinical evaluation and is managed conservatively initially. However, surgery remains the management modality of choice in recalcitrant cases[2] due to the failure of conservative therapies with oral anti-inflammatory medications, local infiltrations, and physical treatments significantly beyond 6 months. With advancements in technology and science, surgical technique has shifted from open procedures to minimally invasive arthroscopic means. Although a steep learning curve is associated with arthroscopic surgeries, being minimally invasive procedures, they are less painful and allow quick postoperative rehabilitation.[3] It also helps in complete visual inspection of the joint being investigated and promptly addresses any other forms of chronic lateral elbow pain like loose bodies or synovial plications. Elbow arthroscopy has been used consistently as a therapeutic modality for treating chronic TE as it is safe, more efficient, and helps in early postoperative recovery and rehabilitation.[4]
Various online platforms have become a boon for learning and knowledge. Also, online education has gained a lot of recognition amongst surgeons worldwide, helping with quick short surgical procedures, which helps impart knowledge in much less time. YouTube is a central online platform that provides a significant source of information on medical conditions, catering to both patients and physicians.[5] However, it is often questioned how much of these shared media are reliable and authentic, as the videos are not peer-reviewed before their online publication. It, hence, can often be misleading for the general mass as seen with earlier studies.[6]
The hypothesis of this study is to test the reliability and quality of videos on tennis elbow arthroscopic surgery published on YouTube using various scoring systems and correlate them with their popularity indices. To the best of our knowledge, no previous studies have systematically studied the tennis elbow videos available on YouTube.
Materials and Methods
The review of the videos was done by two separate authors using three specific search terms on the YouTube search portal.
Search strategy
YouTube was searched on January 15, 2022, and all relevant videos were selected. Only videos published in English were recruited for further analysis. No restrictions were made to the year of publication. Precautions were taken to use a web browser for the search process without any pre-existing saved videos or web-based cookies.
S.B. and B.S.R. were responsible for the initial search. The authors screened the selected videos for all their relevant information addressing the research question of our interest. Disagreements were discussed and evaluated by the senior-most author taking part in this study (R.B.K.), and a provisional list including all the videos was prepared. The final list after the preliminary selection had 74 online videos for quality analysis [Figure 1].
Figure 1.
Preferred reporting items for systematic reviews and meta-analyses chart
Inclusion/exclusion criteria and selection strategy followed
Three search terms were used “tennis elbow arthroscopic surgery,” “Arthroscopic ECRB release,” and “Arthroscopic debridement for tennis elbow.” First, 50 videos against each search term were selected for the analysis after excluding any repetitions. Exclusions were also considered if the videos were not in the English language or there was no audio.
Pilot study
The study was conducted on 20 videos to validate a novel score used in this study (TEARS score). The main study was started only after the validation of this novel scoring system.
Outcomes of interest and definitions
The outcomes of interest for the systematic review of videos included the characteristics of all the videos available on YouTube, such as–the duration of the videos, type of videos, audience, and the various countries from which they were uploaded. The videos included were uploaded by practising surgeons or implant companies as promotional videos. We divided all the available videos based on the population of the targeted audience—physician-oriented or patient-oriented based on the scientific soundness of the videos. Primarily this review meticulously studies the reliability, popularity, and quality of the video content available on YouTube. The reliability of the video graphics information was analysed using the DISCERN and journal of the American medical association (JAMA) scores. The popularity of the videos was characterised by video power index (VPI) and the views ratio. The quality of the various videos was studied using Global Quality Score Criteria (GQSC),[7,8] which included a 5-point rating system.
To increase the specificity of the study, each video was studied with a unique novel TEARS score (tennis elbow arthroscopy-related scoring system) [Table 1]. Based on the pilot studies done by Celik et al.,[9] we developed a novel scoring system (Tennis elbow arthroscopy-related scoring system—TEARS) to assess the quality, reliability, and amount of information derived from each uploaded video. TEARS is similar to the novel Rotator Cuff surgery YouTube score used by Celik et al.[9] Categories were allotted as per score, 0–5: very poor, 6–10: poor, 11–15: moderate, 16–20: good, and 21–25: excellent. Secondary data for each video were collected based on the number of views since upload, the number of likes, days since upload, views/day, likes/day, and likes/view as indirect measures of popularity. Correlation of the quality analysis scores with the likes, duration of the videos, and popularity scores like VPI and views ratio were also determined.
Table 1.
Tennis elbow arthroscopy-related YouTube Scoring System (TEARS)
| Pre surgery (1 point for each) | During surgery and post-surgery (1 point for each except last) |
|---|---|
| Anatomy around lateral epicondyle | Position |
| Timing | Approach |
| Age | Presentation of tennis elbow |
| Gender | Technique |
| Characteristics of pain | implant type and description |
| Associated conditions | Biological agents |
| Clinical tests | Presentation after release of ECRB |
| Imaging | Additional procedures |
| Differential diagnosis | Description of immobilisation |
| Functional disability | Description of the rehabilitation |
| Initial management | Description of complications (relapse, infection, elbow pain, elbow stiffness, neurovascular damage, anaesthesia related problems) – 2 points max, 0.5 for each complication |
| Surgical indications | |
| Surgical contra-indications |
0–5: very poor; 6–10: poor; 11–15: moderate; 16–20: good; and 21–25: very good
Data collection and abstraction
Two investigators (S.B. and S.C.) from India, independently extracted data related to the outcomes, as mentioned earlier, from the videos available on YouTube. The senior author (R.B.K.) decided on the data extraction in case of any disagreements. The data extracted for the review included the characteristics of all the videos based on the primary outcomes and secondary outcomes, as we have mentioned previously.
Statistical analysis
The data was collected in a Microsoft (MS) Excel spreadsheet. Various baseline parameters were checked at first. All continuous variables extracted from the data analysis were expressed as means and standard deviations (SD) with a 95% confidence interval (CI) and categorical variables in absolute numbers and percentages. All data were checked for their normality by the Shapiro–Wilk test. An intra-class correlation coefficient was calculated for the inter-rater reliability against each scoring system. All scoring data were correlated with popularity indices by the Spearman correlation test. Correlation values (expressed in terms of Spearman’s rho) were categorised as poor (0.21–0.40), fair (0.41–0.60), good (0.61–0.80), and excellent (0.81–1.00). Any difference in the video contents between the quality of the videos and the video information data was also compared by the Kruskal–Walis test. A P-value of less than 0.05 was considered statistically significant, whereas any overlap within the 95% CI or P-value more than 0.05 was considered statistically insignificant. SPSS version 25.0 (SPSS Inc., IBM, Chicago, Illinois) for MAC (Macbook version) was used for all statistical analyses.
Results
Each search term yielded 150 videos, out of which 124 relevant videos were selected first. Repetitions accounted for 40 videos, four without any audio or captions, and six videos were non-English, and they were eventually excluded from this review. The final list of 74 videos was selected and subjected to qualitative data analysis [Figure 1].
Pilot study
The novel score (TEARS score) showed results in accordance with other scores used in this study. The video showing poor results in TEARS score also showed poor DISCERN, JAMA, and GQSC scores.
Video content characteristics
Most of the videos available on arthroscopic management of tennis elbow were educational (96%) [Figure 2], and the majority were physician-directed (79%) [Figure 3]. Most of the videos were uploaded by surgeons/practitioners (>80%). A majority of the videos were uploaded from the USA (n = 30, 41%), followed by India (n = 12, 16%) [Figure 4 and Table 2]. The average duration of the videos was 361.27 s or 6.02 min (24–1400 s). The mean views and likes for each video were 41,644.97 and 433.78. the average duration since upload was 1836 days or 5.03 years (170–4498 days). The views/day, likes/day, likes/view, and the view ratio were 34.34, 0.44, 0.0084, and 1156.66, respectively [Table 3].
Figure 2.
Baseline characteristics
Figure 3.
Targeted audience
Figure 4.
Country specific contribution
Table 2.
Baseline characteristics of the video contents on arthroscopic TE surgery available on YouTube
| Variables | Value |
|---|---|
| Duration of Video (seconds) (mean, SD, CI) | 361.27, 306.17, 69.75 (mention range) |
| Type of video (%) | |
| Educational | 96 |
| Promotional | 4 |
| Audience (%) | |
| Physician | 79 |
| Patient | 21 |
| Country, number (%) | |
| 1. USA | 30, (41) |
| 2. India | 12, (16) |
| 3. Unknown | 5, (7) |
| 4. UK | 4, (5) |
| 5. France | 2, (3) |
| 6. Poland | 2, (3) |
| 7. Brazil | 3, (4) |
| 8. Korea | 3, (4) |
| 9. Singapore | 2, (3) |
| 10. Italy | 1, 1) |
| 11. Turkey | 1, 1) |
| 12. Qatar | 3, 4) |
| 13. Ireland | 1, (1) |
| 14. Dubai | 2, (1 ) |
| 15. Japan | 1, (1) |
| 16. Netherlands | 1, (1) |
| 17. Canada | 1, (1) |
CI: confidence interval, SD: standard deviation
Table 3.
Secondary characteristics of the video contents on arthroscopic TE surgery available on YouTube
| Variables | Value (mean, SD) |
|---|---|
| Views | 41,644.97, 226,655.94 |
| Likes | 433.78, 3137.32 |
| Years since upload | 5.03, 3.39 |
| Views/day | 34.34, 240.71 |
| Likes/day | 0.44, 3.42 |
| Likes/view | 0.0084, 0.015 |
| Views ratio | 1156.67, 383.04 |
Reliability
The reliability of the content of the videos available on arthroscopic TE management was determined using the DISCERN and JAMA scores, and they were, on average, 21.47 and 1.05, respectively [Table 4]. DISCERN consists of 16 questions under three sections considering how reliable a publication is, how good the quality of information on treatment choices and the overall rating of the publication.[10] JAMA score consists of four headings such as author (authorship), date (currency), financial ownership (disclosure), and reference (attribution).[11] The inter-rater reliability for these was determined to be good, with the DISCERN score having a weighted kappa being 0.848 (95% CI to be 0.885–0.877) and JAMA score having a weighted kappa of 0.862 (95% CI to be 0.816–0.883) [Table 5].
Table 4.
Score variables
| Variables | Value (mean, SD, CI) |
|---|---|
| DISCERN Score | 21.47, 6.28, 20.04–22.9 |
| JAMA Score | 1.05, 0.92, 0.85–1.25 |
| VPI Score | 769,936.89, 6,538,851.37, 719,882.76–2,259,756.54 |
| TEARS Score | 4.17, 2.62, 3.58–4.76 |
| GQSC Score | 1.70, 0.82, 1.52–1.98 |
SD, standard deviation; CI, confidence interval
Table 5.
Comparison of inter-rater reliability of the various scoring systems
| Scoring variables | Inter-observer reliability (ICC, 95% CI) |
|---|---|
| DISCERN | 0.848 (0.885–0.877) |
| JAMA | 0.862 (0.816–0.883) |
| GQSC | 0.820 (0.727–0.864) |
| TEARS | 0.894 (0.774–0.952) |
| VPI | 0.857 (0.805–0.881) |
| Views ratio | 0.942 (0.805–0.993) |
Quality
The quality analysis was done based on two scoring systems GQSC and the TEARS system, with the mean being 1.70 and 4.17, respectively [Table 4]. The inter-rater reliability was noted to be good, with the weighted kappa value for GQSC being 0.820 (95% CI being 0.727–0.864) and TEARS being 0.894 (95% CI to be 0.774–0.952) [Table 5].
Popularity
The popularity index of the various videos was calculated based on the video power index (VPI) ([like count/dislike count + like count] × 100).[12] The mean value of the VPI was 769,936.89, and the SD was 6,538,852.37 [Table 4].
None of the videos published on the medium had any dislike counts. The inter-rater reliability suggested the agreement regarding the two different scorers was good, with the weighted Kappa value of 0.862 and 95% CI 0.816–0.883 [Table 5]. The views ratio was noted to have a mean of 1156.67 and SD 383.04 [Table 3]. The inter-rater reliability suggested an excellent agreement with the weighted Kappa value of 0.942 and 95% CI 0.805–0.993 [Table 5].
The present study highlights, physician targeted outcomes were very poor—41/59 (69%), poor—18/59 (30%), moderate—1/59 (0.017%), good—0, and very good—0; patient targeted outcomes were very poor—14/15 (93.3%), poor—1/15 (0.067%), moderate—0, good—0, and very good—0. Statistically, a significant difference was seen with very poor to moderate TEARS graded videos and VPI, and both physicians targeted category and patients targeted [Table 6]. No significant differences were noted among the secondary data categories [Table 7]. According to the secondary data categories, days since upload, views/day, likes/day, likes/views, and view ratio were measured [Table 7].
Table 6.
TEARS specific other scoring systems
| Variable | Value (mean, SD) | |||
|---|---|---|---|---|
| DISCERN | JAMA | VPI | GQSC | |
| TEARS category (physician targeted) | ||||
| Very poor | 18.92, 4.47 | 0.75, 0.90 | 2,562.93, 15,960.47 | 1.09, 0.29 |
| Poor | 25.83, 6.57 | 1.61, 0.82 | 760.13, 2033.18 | 2.33, 0.66 |
| Moderate | 42, 0 | 2, 0 | 28.62, 0 | 3, 0 |
| P-value | 0.567 | 0.081 | 0.043 | 0.06 |
| TEARS category (patient targeted) | ||||
| Very poor | 21.76, 4.72 | 1.07, 0.82 | 4,358,927.8, 15,091,625.2 | 2.38, 0.48 |
| Poor | 24, 0 | 1, 0 | 19,0540, 0 | 4, 0 |
| P-value | 0.474 | 0.328 | 0.036 | 0.072 |
Significant P value in bold style. Kruskal–Walis test used for comparison
Table 7.
TEARS-related secondary data
| Variable | Value (mean, SD) | ||||
|---|---|---|---|---|---|
| Days since upload | Views/day | Likes/day | Likes/view | Views ratio | |
| TEARS category (physician targeted) | |||||
| Very poor | 1686.78, 1247.91 | 4.04, 15.36 | 0.0148, 0.042 | 0.0059, 0.0072 | 892.34, 321.23 |
| Poor | 1932.94, 1273.92 | 4.09, 6.29 | 0.058, 0.12 | 0.015, 0.02 | 922.87, 302.34 |
| Moderate | 1730, 0 | 1.59, 0 | 0.01, 0 | 0.0066, 0 | 1179.54, 392.42 |
| P-value | 0.062 | 0.057 | 0.823 | 0.256 | 0.061 |
| TEARS category (patient targeted) | |||||
| Very poor | 2109.38, 1188.77 | 166.78, 553.56 | 2.34, 7.88 | 0.0087, 0.0068 | 946.67, 342.56 |
| Poor | 2616, 0 | 136.1, 0 | 0.535, 0 | 0.004, 0 | 1024.76, 303.25 |
| P-value | 0.752 | 0.231 | 0.056 | 0.891 | 0.078 |
A negative association to poor correlation was noted between the duration of the videos and their quality scores [Table 8].
Table 8.
Correlation between the popularity variables and various scoring systems
| Variables | DISCERN (rho, P) | JAMA (rho, P) | GQSC (rho, P) | TEARS (rho, P) | VPI (rho, P) |
|---|---|---|---|---|---|
| Views | 0.062, 0.60 | −0.055, 0.641 | 0.218, 0.064 | 0.053, 0.656 | 0.451, 0.00 |
| Likes | 0.369, 0.001 | 0.277, 0.018 | 0.436, 0.00 | 0.319, 0.006 | 0.962, 0.001 |
| Duration | −0.0480, 0.56 | −0.0370, 0.21 | 0.045, 0.07 | 0.0236, 0.08 | 0.376, 0.001 |
| Views ratio | 0.282, 0.016 | 0.290, 0.013 | 0.303, 0.001 | 0.24, 0.041 | 0.891, 0.00 |
| VPI | 0.344, 0.003 | 0.299, 0.01 | 0.416, 0.00 | 0.303, 0.009 | – |
Significance of bold values: TEARS score correlate well with VPI score
Discussion
According to this present study, the reliability and quality of the video content available on arthroscopic management of TE on YouTube were objectively analysed to be extremely poor. The popularity of the videos was calculated to be relatively high according to the views ratio and VPI scores. VPI scores have a statistically positive correlation. None of the videos had any dislikes by the viewers. This objective scoring data questions the overall content quality of the videos on arthroscopic TE surgery available on YouTube.
Over the years, the Internet has evolved, and as high as 70% of the general mass consult the web for various health-related information.[13] YouTube is an extensive platform with over 500 h of non-peer-reviewed open-access video content uploaded every minute.[14] It remains one of the most widely accessed informative social media platforms today. Several studies have also highlighted the frequent integration of online content and conventional didactic lectures, especially after the pandemic.[15] This paradigm shift has revolutionised the medical education system with more and more focus on online educational content. With its comprehensive, freely accessible video content, YouTube remains very useful for a quick browse and helps in adding to the knowledge gathered from textbooks. Most of the surgical trainees at times use YouTube as a source of learning new techniques/topics. Though these online educational tools should not be the only source of education, they can be valuable adjuncts to the conventional educational system. Most of the content on YouTube is never peer-reviewed and is published quickly; hence the quality of the content remains debatable always.[16] One of the earliest studies by Keelan et al.[17] on the available YouTube videos on immunisation states poor quality information on various medical conditions. Several other studies have also previously highlighted the YouTube video on the arthroscopic anterior cruciate ligament reconstruction,[18] rotator cuff surgeries,[9] Bankart repair,[19] lumbar fusion surgeries,[20] knee arthroplasty,[21] and gastric surgeries[22] are of poor quality. The present study on arthroscopic TE surgeries also emphasises a similar finding. While these short videos may be beneficial as an adjunct to conventional medical education, they can be a double-edged sword and wrong or poor-quality information may be passed on to the general public. Several studies have emphasised that many health-related sites contain poor quality and misleading information.[23,24] Such misleading information can immensely influence patients’ health outcomes. Misleading information on multiple ailments is just a click away, and mainly general masses accept such content without much thinking. Before consulting a physician, they would have accessed and studied various possibilities depending on their symptoms. This study results thus highlight that video content on the surgical management of one the most commonly diagnosed condition of chronic elbow pain is unreliable and poor in quality. Even when most of the available content targeted physicians, their reliability and overall quality were questionable.
Tennis elbow is an important cause of debilitating recurrent lateral elbow pain, leading to immense functional limitation. Conservative and different modalities of physical therapies are considered the usual first-line treatment modalities and primarily result in symptomatic relief.[25] However, around 3%–11% of all the patients diagnosed with TE develop chronic symptoms.[26] Surgical management is considered the treatment of choice in this particular cohort of patients. Several surgical techniques like the open release of ECRB,[27] Nirschl’s procedures,[28] percutaneous tenotomies,[29] and even micro-ablation[30] have been tried. Arthroscopic treatment in such recalcitrant cases has shown to be comparable to open surgical procedures in terms of functional outcomes.[31] Being minimally invasive helps in early pain relief and post-surgical recovery of functions.[32] With the increasing patient demand and a more significant number of orthopaedic surgeons being trained with arthroscopic techniques, arthroscopic management for TE is on the rise, and arthroscopic release of ECRB tendon is one of the well-accepted management modalities of recalcitrant TE. The correlation analysis of the popularity indices like VPI and the views ratio showed a poor correlation with the quality and reliability scores. Ferhatoglu et al.[33] and Celik et al.[9] reported a negative association between the popularity of the videos with quality scores. This proves that most viewers were interested in watching low-quality videos. The popularity of the videos depends on various factors like the duration of the videos[34] and likes on the video content. Our study highlights the number of likes on the videos had an excellent correlation value with VPI. The average duration of each video on TE arthroscopy was around 6 min. A negative association to very poor correlation was seen between quality scores and the duration of the videos. However, a poor positive correlation was seen between VPI and the video durations. This signifies that the viewers were more interested in shorter videos. A similar finding has been reported in the literature by Biggs et al.[35] and Celik et al.[9] YouTube can be considered a very influential social media platform for the dissipation of health-related information. It is time that the large numbers of video content on arthroscopic TE management in this medium were reviewed systematically for their reliability, quality, and overall popularity.
The strength of the current study highlights the various scoring systems used objectively by two different reviewers and the high inter-observer agreement between them. The correlation between the popularity of videos with their quality analysis scores was also determined, which also remains an essential strength of the present study. One of the most important, novel scoring systems used in this study to categorise the videos, the TEARS score, can be considered invalid. However, the same score has been previously used in many studies. To make the score appropriate for rating TE videos, we had to modify the tool a bit. Further analyses for the validity of our TEARS score can be considered in the future. Although YouTube was carefully searched for inclusion of all the videos, inadvertently, some videos might not have been included in this qualitative data analysis. Videos were searched at only one point in time; this may also be considered a limitation of the present review.
Authors’ contribution
AKC: Planning of study, literature search, writing the manuscript, quality assessment of the included studies. SB: Data management, outcome assessment, manuscript preparation, revising the manuscript. SC: Literature search, writing the manuscript, quality assessment of the included studies. BSR: Data management, outcome assessment, manuscript preparation. SP: Literature search, writing the manuscript, quality assessment of the included studies. RBK: Planning of study, quality assessment of the included studies, writing and revising the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
Although the videos available on YouTube on arthroscopic surgery for TE are popular, the overall quality and reliability were inferior. The various information available through these videos are still very premature to be considered good quality scientific evidence.
References
- 1.Buchanan BK, Varacallo M. Tennis Elbow. 2022 Nov 7. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2023. [PubMed] [Google Scholar]
- 2.Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: One size does not fit all. J Orthop Sports Phys Ther. 2015;45:938–49. doi: 10.2519/jospt.2015.5841. [DOI] [PubMed] [Google Scholar]
- 3.Pierce TP, Issa K, Gilbert BT, Hanly B, Festa A, McInerney VK, et al. A systematic review of tennis elbow surgery: Open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy. 2017;33:1260–1268.e2. doi: 10.1016/j.arthro.2017.01.042. [DOI] [PubMed] [Google Scholar]
- 4.Dodson CC, Nho SJ, Williams RJ, Altchek DW. Elbow arthroscopy. J Am Acad Orthop Surg. 2008;16:574–85. doi: 10.5435/00124635-200810000-00003. [DOI] [PubMed] [Google Scholar]
- 5.Desai T, Shariff A, Dhingra V, Minhas D, Eure M, Kats M. Is content really king? An objective analysis of the public’s response to medical videos on YouTube. PLoS One. 2013;8:e82469. doi: 10.1371/journal.pone.0082469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Li HO-Y, Bailey A, Huynh D, Chan J. YouTube as a source of information on COVID-19: A pandemic of misinformation? BMJ Glob Health. 2020;5:e002604. doi: 10.1136/bmjgh-2020-002604. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Singh AG, Singh S, Singh PP. YouTube for information on rheumatoid arthritis—A wakeup call? J Rheumatol. 2012;39:899–903. doi: 10.3899/jrheum.111114. [DOI] [PubMed] [Google Scholar]
- 8.Bernard A, Langille M, Hughes S, Rose C, Leddin D, Veldhuyzen van Zanten S. A systematic review of patient inflammatory bowel disease information resources on the World Wide Web. Am J Gastroenterol. 2007;102:2070–7. doi: 10.1111/j.1572-0241.2007.01325.x. [DOI] [PubMed] [Google Scholar]
- 9.Celik H, Polat O, Ozcan C, Camur S, Kilinc BE, Uzun M. Assessment of the quality and reliability of the information on rotator cuff repair on YouTube. Orthop Traumatol Surg Res. 2020;106:31–4. doi: 10.1016/j.otsr.2019.10.004. [DOI] [PubMed] [Google Scholar]
- 10.Charnock D, Shepperd S, Needham G, Gann R. DISCERN: An instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999;53:105–11. doi: 10.1136/jech.53.2.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the internet: Caveant lector et viewor—let the reader and viewer beware. JAMA. 1997;277:1244–5. [PubMed] [Google Scholar]
- 12.Erdem MN, Karaca S. Evaluating the accuracy and quality of the information in Kyphosis videos shared on YouTube. Spine. 2018;43:E1334–9. doi: 10.1097/BRS.0000000000002691. [DOI] [PubMed] [Google Scholar]
- 13.Tonsaker T, Bartlett G, Trpkov C. Health information on the Internet. Can Fam Physician. 2014;60:407–8. [PMC free article] [PubMed] [Google Scholar]
- 14.YouTube: Hours of video uploaded every minute. Statista. [Last Accessed on 14 Apr 2022]. Available from: https://www.statista.com/statistics/259477/hours-of-video-uploaded-to-youtube-every-minute/
- 15.Raja BS, Choudhury AK, Paul S, Rajkumar S, Kalia RB. Online educational resources for orthopaedic residency – a narrative review. Int Orthop. 2021;45:1911–22. doi: 10.1007/s00264-021-05101-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Mostafa MM, Feizollah A, Anuar NB. Fifteen years of YouTube scholarly research: Knowledge structure, collaborative networks, and trending topics. Multimed Tools Appl. 2023;82:12423–43. doi: 10.1007/s11042-022-13908-7. doi: 10.1007/s11042-022-13908-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Keelan J, Pavri-Garcia V, Tomlinson G, Wilson K. YouTube as a source of information on immunization: A content analysis. JAMA. 2007;298:2482–4. doi: 10.1001/jama.298.21.2482. [DOI] [PubMed] [Google Scholar]
- 18.Springer B, Bechler U, Koller U, Windhager R, Waldstein W. YouTube videos provide poor information quality, reliability and accuracy regarding rehabilitation and return to sport after ACL reconstruction. Arthrosc J Arthrosc Relat Surg. 2020;36 doi: 10.1016/j.arthro.2020.07.013. doi: 10.1016/j.arthro.2020.07.013. [DOI] [PubMed] [Google Scholar]
- 19.Akpolat AO, Kurdal DP. Is quality of YouTube content on Bankart lesion and its surgical treatment adequate? J Orthop Surg. 2020;15:78. doi: 10.1186/s13018-020-01590-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Ahuja K, Aggarwal P, Sareen JR, Mohindru S, Kandwal P. Comprehensiveness and reliability of YouTube as an information portal for lumbar spinal fusion: A systematic review of video content. Int J Spine Surg. 2021;15:179–85. doi: 10.14444/8023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Wong M, Desai B, Bautista M, Kwon O, Kolodychuk N, Chimento G. YouTube is a poor source of patient information for knee arthroplasty and knee osteoarthritis. Arthroplasty Today. 2018;5:78–82. doi: 10.1016/j.artd.2018.09.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Erdem H, Sisik A. The reliability of bariatric surgery videos in YouTube platform. Obes Surg. 2018;28:712–6. doi: 10.1007/s11695-017-2911-3. [DOI] [PubMed] [Google Scholar]
- 23.Suarez-Lledo V, Alvarez-Galvez J. Prevalence of health misinformation on social media: Systematic review. J Med Internet Res. 2021;23:e17187. doi: 10.2196/17187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Borges do Nascimento IJ, Pizarro AB, Almeida JM, Azzopardi-Muscat N, Gonçalves MA, Björklund M, et al. Infodemics and health misinformation: A systematic review of reviews. Bull World Health Organ. 2022;100:544–61. doi: 10.2471/BLT.21.287654. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Chesterton LS, Mallen CD, Hay EM. Management of tennis elbow. Open Access J Sports Med. 2011;2:53–9. doi: 10.2147/OAJSM.S10310. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: Challenges and solutions. Open Access J Sports Med. 2018;9:243–51. doi: 10.2147/OAJSM.S160974. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Open Release for Lateral Epicondylitis. [Last accessed on 14 Apr 2022]. Available from: https://www.orthogate.org/articles/shoulder-and-elbow/80807-open-release-for-lateral-epicondylitis .
- 28.Khashaba A. Nirschl tennis elbow release with or without drilling. Br J Sports Med. 2001;35:200–1. doi: 10.1136/bjsm.35.3.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Panthi S, Khatri K, Kharel K, Byanjankar S, Shrestha R, Sharma JR, et al. Outcome of percutaneous release of tennis elbow: A non-randomized controlled trial study. Cureus. 2017;9:e952. doi: 10.7759/cureus.952. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Tasto JP, Richmond JM, Cummings JR, Hardesty R, Amiel D. Radiofrequency microtenotomy for elbow epicondylitis: Midterm results. Am J Orthop Belle Mead NJ. 2016;45:29–33. [PubMed] [Google Scholar]
- 31.Leiter J, Clark T, McRae S, Dubberley J, MacDonald PB. Open versus arthroscopic tennis elbow release. Orthop J Sports Med. 2016;4:2325967116S0016. [Google Scholar]
- 32.Pierce TP, Issa K, Gilbert BT, Hanly B, Festa A, McInerney VK, et al. A systematic review of tennis elbow surgery: Open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy. 2017;33:1260–1268.e2. doi: 10.1016/j.arthro.2017.01.042. [DOI] [PubMed] [Google Scholar]
- 33.Ferhatoglu MF, Kartal A, Ekici U, Gurkan A. Evaluation of the reliability, utility, and quality of the information in sleeve gastrectomy videos shared on open access video sharing platform YouTube. Obes Surg. 2019;29:1477–84. doi: 10.1007/s11695-019-03738-2. [DOI] [PubMed] [Google Scholar]
- 34.Gokcen HB, Gumussuyu G. A quality analysis of disc herniation videos on YouTube. World Neurosurg. 2019;124:e799–804. doi: 10.1016/j.wneu.2019.01.146. [DOI] [PubMed] [Google Scholar]
- 35.Biggs TC, Bird JH, Harries PG, Salib RJ. YouTube as a source of information on rhinosinusitis: The good, the bad and the ugly. J Laryngol Otol. 2013;127:749–54. doi: 10.1017/S0022215113001473. [DOI] [PubMed] [Google Scholar]